Dopers in countries with universal health care - how does non-health insurance handle health issues? For example, my (US) auto insurance has bodily injury coverage for health costs related to an accident and my homeowners insurance covers injuries at my house or on my property. Are these costs just assumed by the healthcare system?
It may be different in some other countries, but in Britain it makes no difference what caused the health issues. If it is a genuine health issue (and not merely cosmetic, or something like that) it is covered by the NHS. Auto insurance and teh like does not cover, because it does not need to cover, bodily injury, either to the insured or to third parties.
Spain.
Car insurance is for the car, not the driver. It may or may not include health damage to drivers, passengers and third parties, which in any case will be payouts rather than direct healthcare coverage. Home, similar.
The healthcare system is divided in three parts, theoretically:
- Social Security covers anything non-work-related and not elective. This includes being able to go to a public healthcare system doctor anywhere in the country (this is where the “theoretically” comes in, as now that each region administers their own healthcare each has its own notions about what and who is covered) or, with a EU-SS card, anywhere in the EU plus several neighboring countries.
Example of elective: you’ve been in a car crash and have broken your nose. You’ve got the right to reconstructive surgery.
Example of non-elective: you don’t like your nose. There’s nothing medically wrong with it, you simply have decided that your Roman profile isn’t appropriate (cmon, you’re from Spain, our idea of “smallish nose” is Bob Hope). Tough titty, go see number 3. - There is a second network of healthcare centers which specializes in the prevention of work injuries and in their treatment. These grew from insurance companies but at one point got separated by law. The workers do not pay into them directly: workers/companies must tell SS which network they want to be covered by, and SS transfers the money. This money pays for such services as yearly checkups, new hire checkups and work-injury/illness treatment; you can also hire these companies with additional payment to act as your Work Safety Officers (I’ve got a WSO degree and I’m a company of one, so I act as my own WSO).
- There is also private healthcare, and private “insurance” (which sometimes isn’t exactly insurance as what it offers is preferential care, not cheaper bills) offered by some private networks or hospitals, but too often these are either outright lies (they would have called you for that date if you’d gone via SS anyway) or double-billing schemes (the center charges you because you’ve gone private, then they turn around and bill SS). Also, in general when those centers want you to get a procedure they cannot do themselves… they send you to the public system! Not to another private, expensive, “you’ll be in and out in a minute” (except when not) place, but to the public healthcare system. Most people get their dental care privately (public covers fillings and extractions, but not braces for esthetic reasons, sleeves…): dental insurance can be worth it, the rest generally is not.
Injuries, however caused, are all covered by healthcare. But any additional costs to you, like missing work, on going disability costs, inability to work, pain and suffering, etc, would all be something you could sue for and be awarded. In some cases car insurance or house insurance would pay those costs very likely.
A lot of companies offer a supplemental healthcare plan, too, to pay for things like ambulances, upgraded hospital rooms, physiotherapy, drugs, etc. If I injured myself falling on some ice on a homeowner’s sidewalk, the medical costs would all be born by the universal healthcare system, but I could possibly sue the homeowner for lost wages. As I understand it, our legal system has significantly fewer injury suits due to healthcare costs being universally covered, however - there is a lot less incentive to sue when you don’t have huge medical bills.
Pinmin, universal health care (in the UK) is just that - you get sick, you go to see tour GP (no copay). You get injured, go to the ER or an NHS walk in centre (no copay). The cause or location is irrelevant. Home insurance, car insurance and the like will often include cover for time off work through injury or ill- health, but the medical bills are covered. In fact, you never see a medical bill.
Now, some jobs come with private health insurance as a perk - this gives you access to immediate care with hard to book physiotherapists (for example) or a private room in a private hospital that feels like a nice hotel but it’s not necessity.
In Australia in my state Victoria - as part of your car registration there is a charge for the “Transport Accident Commission” which covers extra on top of what is provided as part of the universal health care. From their website “The TAC will pay the reasonable costs of medical treatment, rehabilitation services, disability services, income assistance, travel and household support services that you may need as a result of your injuries from a transport accident.”
A friend of mine has claimed through them and it is quite amazing what she has received.
For injuries at home … unless it is a third party suing for damages (which requires third party as part of home insurance) … injuries are just treated in the same manner … you go to the doctor etc.
When I was injured at work, I was taken to hospital where I had extensive surgery to my leg, including having a titanium pin to hold my tibia together while it healed. This included a week in a hospital bed, a lot of antibiotics and pain relief. After discharge I attended several outpatient clinics for an x-ray and a consult with an orthopaedic doctor. All of this was provided under the NHS.
I started an action against my employer, my legal costs being paid for by my home-owners policy. My employer (or rather their insurance Co) paid for some physio, and I also had to visit another consultant privately with more x-rays, all of which was paid for directly by the insurance. This was largely to agree on the long term prognosis.
When the claim was settled it came as two parts. General and Special damages. General damages are compensation for pain & suffering, loss of promotion or other opportunities, disadvantage in the labour market, inability to carry out day to day tasks / hobbies, future loss of earnings etc. Special damages are compensation for money lost which you can put a figure on. Examples are lost wages, money spent on travel, prescription fees, buying special equipment, etc.
Prescriptions here are free for many people (me as a pensioner for example) but others have to pay £8 or so for them.
Damages are theoretically decided by a court; in practice they are almost always decided by agreement.
Folks responding: please specify the country you’re in. The health care systems are very different from country to country. Some countries’ health care systems are comprehensive, covering everything in all directions (like Germany); some legally require private supplements; some don’t legally require supplements, but you wouldn’t want to use that national system (like most third world countries); in some (like the UK or Canada) private supplements mean a better level of care (e.g., private hospital rooms.)
As a generalization: most health care systems don’t care what caused the illness/injury, they cover it as they would anything else.
Note to self: do not write at 5 eyem…
Evidently, I crossed the elective/non-elective examples. Broken nose: non-elective (covered under public healthcare); disliked nose: elective (pay through the aforementioned apendage).
In the UK, if you could convince a psychiatrist that your massive Cyrano-like proboscis was causing you serious problems, you may well get the necessary surgery done on the NHS. If you merely want rhinoplasty to remove the recherche tip then you will have to pay. There is a wide grey line between the two extremes.
Is this a flat fee / surcharge, or does the cost vary based on your risk like the auto insurance cost?
It’s a flat rate for each vehicle type. The TAC premium for regular light vehicle is about $350 per year. Commercial vehicles, truck, buses and motorcycles pay a different (higher I think) rate.
Also the state uses it as a sort of stealthy tax, they only pay out about half of what they collect and pay the rest as a “dividend” to the government.
In my province, Saskatchewan, all medical costs are covered. However, there used to be a special rule for injuries in car accidents. If you were hurt in a car accident, you were covered just like any other injury, but if you sued the other driver, you were required to include a claim for the medical costs, subrogated to the gov’t health care, so that the other driver’s insurance would pay for the health costs, if the other driver was found liable for the accident.
We’ve now gone to a no-fault system, so that doesn’t happen any more. Just straight coverage by the health care system.
Japan
National health insurance pays on everything, regardless of cause. However, there is a co-payment required. There can be other expenses as well.
Car insurance will cover up to certain limits, the more money you pay, the greater the benefit.
People also get supplemental health insurance which often just provides a set payment per day of hospitalization, for example, which you can use for private or semi-private rooms or other expenses, but you could also just pocket.
Follow-up to my earlier post - if you’re injured at work, your health care is covered by the regular health care system. You also get workers’ compensation on a no-fault basis. That covers lost income and therapy that exceeds what is provided by the health care system. Since it’s no-fault, you don’t sue the employer, unlike the example given by bob+ in the UK. The workers’ comp system is funded entirely by mandatory assessments on all employers. Employees don’t pay premiums.
Yes, in most provinces in Canada (Health care is provincial, allegedly supplemented by federal funding to help pay) the health system covers everything that is a real medical problem. For example, they might cover something like stomach banding if you are morbidly obese (so I’ve heard) but have published criteria - how much overweight you have to be. You can have a tummy tuck, from what I’ve heard, but only if you’ve lost over 100lb so you skin is VERY loose there. I suppose the major advantage is that the list of covered procedures and qualifying criteria in each province is a published list. With only one provider, one billing form, everyone covered, it sure makes the physician’s paperwork simple.
Some provinces have private auto insurance and some have a provincial “crown corporation” (government-chartered body) that provides insurance (British Columbia, Saskatchewan?) Actual medical costs from accidents are covered by the health care system, in general. I have heard that the auto insurance covers things like chiropractic care and physiotherapy and other costs that might be linked to long term residual effects of an accident, as opposed to immediate medical care. I recall an article several years ago complaining about the “no fault” system (Manitoba, I think?) that they limited the amount paid for additional therapy and instituted a rule “no damage to the car, no payout” about claims for treatment of whiplash etc.
Note too that the rule in Canada (national standard) is that if the doctor charges more that the provincial fee schedule neither they nor the patient are reimbursed. Thus, a doctor that wants to charge extra basically works outside the system. Better employers offer “supplemental insurance” through Blue Cross and the like, but as mentioned this covers the perks - private rooms, TV rental in the hospital, ambulances, some things like wheelchair rental. Nobody offers “medical coverage” like in the USA and nobody wants to start that rat race, so private doctors are limited to a small pool - the 1%, sports teams, etc. - where money is plentiful and bypassing the inevitable queues is more important.
The exception is Worker’s Compensation. Worker’s Comp treatments IIRC are billed to the WCB (Board) so the first thing a doctor might ask is “did this happen at work?” Medical costs are tracked and each company pays a premium based on the average claims against their industry, serious accidents or unusually high rates of claims bring on investigations, etc.
**Piper **is the expert about this topic IIRC, but generally in Canada (a) with no medical bills, the total amount is much much lower and not worth suing over, (b) the losing party more often than not has to pay the winner’s legal bills, and © general pain and suffering awards (ie. money for nothing) are much lower in Canada, and (d) given a-c and the general discouragement of contingency fees by the provincial bar associations (from what I’ve read) very few lawsuits are filed unless it’s a really serious accident.
A friend of mine in college told me of a lecture by a prominent lawyer in the 1970’s who made the cynical remark “if you run over a child, back up and make sure he’s dead”. The damages you might pay for a dead child would be quite low. The damages for a child needing a lifetime of round-the-clock care (quadriplegic, brain damage, or such) would be astronomical. You personally, or your insurance, would be the first place dinged by a lawsuit for the cost of such care. A person with decent resources as a result of such a settlement would get better care - private nurse at home instead of being in an institution, etc. That settlement would come from car insurance, home insurance, or whatever covers the incident. My car insurance, for example, carries over a million in liability (5 million, I think). That would cover settlements such as care for a person I injured, or it might cover the physical damage like if I crashed into an expensive building and it burned down. (Jerry Pournelle in his blog many years ago told of some guy crashing into a high-voltage pole which dropped the 15,000Volt lines onto the household feed. Light bulbs, TVs, kitchen appliances, computers etc. for blocks around exploded or fried. Someone’s insurance paid for that damage) My insurance also covers situations like when I drive in the USA where medical bills would be an issue.
To say “a better level of care” is misleading. In Britain, at least, the actual medical treatment you will get in most circumstances is the same (which is what is usually meant by “healthcare” in this context). Yes, private insurance may get you a private room that you might not get otherwise (f there was no medical need for it), or other medically irrelevant comforts, and it might get you nearer to the front of the queue for elective treatments. That, though, is not relevant to the OP.
Germany:
Injuries for which someone else may be liable (excluding work accidents): The statutory insurance scheme you have chosen (or private medical insurance if you have opted for that) covers medical treatment the same way they’d cover for any other cause. If the diagnosis code indicates any kind of injury they send the injured person a questionnaire asking for information on time/place/circumstances, if a third party may be liable, if it was a case of assault in which case please provide police report reference etc. In cases where that information looks if a third party may be liable they go after that third party to get reimbursed for the medical costs. In that case that third party obviously will use their relevant non-medical insurance policies (car third-party liability, homeowner’s insurance, general liability insurance)
As the liability for gravely injuring someone may be for very large sums (worst case: putting a young person in need of full nursing care for a normal lifespan), general (i.e. non-car) liability insurance is the one non-mandatory but indispensable policy every German should take out. It’s not that expensive - IIRRC I pay about 60 EUR/yr for that.
Injuries at work/on the way from and to work/work-related diseases: on first treating such an injury the box “work/way to work injury” is checked and at that point the employer’s statutory worker’s compensation carrier takes over from the worker’s personal medical insurance carrier. It is advantageous for the worker to have an injury or a disease classed as work/way-to-work as disability payments are more generous than for non-work injuries. Because of this there are a lot of court decision on in which cases a stop for a chore/a drink/a visit/shopping on the way home from work counts as an end to the way home covered by worker’s comp or only pauses the way home.
Well, not everything. Unless things have greatly changed recently, prescription drugs aren’t covered, for instance.